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Catheter Replacement Rates In Labor; Combined Spinal-Epidural Versus Epidural technique
Abstract Number: T-16
Abstract Type: Original Research
Introduction: The combined spinal-epidural (CSE) technique for labor analgesia possesses several advantages over the traditional epidural (EPI) technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses.1 We have compared the failure rates between techniques in our tertiary care academic practice.
Methods: Information about failed catheters (FCs) from CSE and EPI techniques was collected prospectively from Oct. 2012-Sept. 2013 as part of our Quality Assurance program. IRB approval was obtained for analysis. FCs were defined as those replaced for being: intravascular (except those noted immediately at placement), one sided, inadequate to provide maternal analgesia or inability to extend the epidural for cesarean delivery (CD). Once a FC was identified, the following information was obtained: age, height, weight, BMI, gravity, parity, skin to epidural space depth, catheter mark at skin, number of physician boluses and time elapsed between placement to identification. Fishers exact test was used to examine the difference in failure rate between the techniques during labor and CD.
Results: During the study period 2780 neuraxial techniques were performed (853 Epi; 1927 CSE), with no demographic differences between the groups (Table 1). A total of 38 CSE (1.97%) and 40 Epi (4.69%) catheters were replaced during labor (P < 0.001). 488 patients (310 CSE; 178 Epi, P=0.002) required extension of the epidural for CD. FCs during CD were 26 CSE (8.4%) and 18 Epi (10.1%) catheters, P = 0.314. CDs that were classified as stat/emergent with insufficient time to allow epidural catheter dosing were excluded from the CD FC analysis.
Conclusion: Reported FC rates vary from 1.6%1 to up to 6.8%2 or higher, depending on physician experience and practice setting. Our data demonstrates that failure rates during labor are lower with CSE than with traditional EPI. The confirmation of needle location with cerebrospinal fluid backflow via the spinal needle after using a loss of resistance (LOR) technique is less subjective than the LOR technique alone. This may be particularly true when procedures are performed by residents. Limitations of our study and analysis include that technique was not randomized, and that we did not collect data regarding the level of experience of the physician performing the technique.
1. Gambling D. Anesth Analg 2013;116:636–43.
2. Pan PH. Int J Obstet Anesth 2004;13:227–33.